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201403980 <br /> d <br /> LIMITATION ON AGENT'S AUTHORITY <br /> If I did not check the"Power of Personal and Family Maintenance"or the"All Preceding <br /> Subjects"in the Grant of General Authority above, my agent MAY NOT use my property to <br /> benefit themselves or anyone they support except for those items listed below in the Special <br /> Instructions. <br /> SPECIAL INSTRUCTIONS(OPTIONAL) <br /> You may give special instructions on the following lines: <br /> N/A <br /> N/A <br /> N/A <br /> N/A <br /> N/A <br /> N/A <br /> NOMINATION OF [CONSERVATOR OR GUARDIAN] (OPTIONAL) <br /> If it becomes necessary for a court to appoint a conservator of my estate, I nominate the <br /> following person(s) for appointment: <br /> Name of Nominee for conservator of my estate:N/A <br /> Address: N/A <br /> Telephone Number: N/A <br /> If it becomes necessary for a court to appoint a guardian of my person, I nominate the <br /> following person(s) for app ointment: <br /> Name of Nominee for guardian of my person: N/A <br /> Address: N/A <br /> Telephone Number: N/A <br /> RELIANCE ON THIS POWER OF ATTORNEY <br /> Any person, including my agent,may rely upon the validity of this power of attorney or a <br /> copy of it unless that person knows it has terminated or is invalid. <br /> EFFECTIVE DATE: This power of attorney is effective immediately unless I have stated <br /> otherwise in the special Instructions. <br /> Page 3 of 4 <br /> Power of Attorney, DC 6:12 PSC,Rev. 08/12 §30-4041 <br />